罗库溴铵对良、恶性肿瘤患者肌松时间的影响

Effect of rocuronium on muscle relaxants time in patients with different types of cancer

目的比较罗库溴铵对良、恶性肿瘤患者肌松时间的影响。方法选择肿瘤患者64例，拟在全身麻醉下行肿瘤切除手术，按不同肿瘤类型分为恶性肿瘤组（对照组）、良性肿瘤组（观察组），每组32例。行静脉注射瑞芬太尼、丙泊酚、罗库溴铵麻醉诱导。在4个成串刺激中的第1个颤搐反应（T1）达最大抑制行气管插管并记录时间。调节靶控输注丙泊酚，血浆浓度3-5μg／mL及间断静脉注射瑞芬太尼维持麻醉。50mg罗库溴铵加入0．9％氯化钠注射液50mL中稀释，当T1恢复到10％时开始静脉泵输注稀释的罗库溴铵，维持患者T1在5％～10％，待患者意识恢复，拔除气管导管。结果两组入室时收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）水平差异无统计学意义（t=0．15，P=0．44；t=0．17，P=0．43；t=0．09，P=0．46；t=0．31，P：0．38）；插管时DBP、MAP、HR水平有所升高，SBP有所降低，其中两组SBP、DBP与入室时差异有统计学意义（t：2．33，P=0．01；t=2．18，P=0．02；t=3．44，P=0．00；t=3．09，P=0．00）；肌松指标：观察组起效时间（98．28±19．97）s、最大效果持续时间（19．97±1．80）S、T1恢复到10％的时间（26．45±0．94）min、T1自10％恢复到25％的时间（13．14±1．12）min、恢复指数（11．67±0．36）min，均优于对照组（t=2．57，P=0．01；t=3．11，P=0．00；t=3．127，P=0．00；t=5．23，P=0．00；t=15．31，P=0．00）；气管插管条件观察组优于对照组，但差异无统计学意义（P〉0．05）。结论良性肿瘤和恶性肿瘤患者应用罗库溴铵后生命体征变化差异无统计学意义，但良性肿瘤患者对罗库溴铵肌松效果较恶性肿瘤患者敏感，起效时间和恢复时间有所缩短，但整体插管条件差异无统计学意义，在今后选择罗库溴铵作为肌松药物的情况下，针对患者合并良、恶性肿瘤可选择适宜的麻醉方式，在剂量、追加频次方面应有所斟酌。

Objective To observe the effect of rocuronium on muscle relaxation time in patients with different types of cancer. Methods Sixty - four patients with tumor were enrolled. The patients underwent tumor resection under general anesthesia. They were divided into malignant tumor group （ control group） and benign tumor group （observation group） according to different tumor type,32 cases in each group. Remifentanil,propofol,rocuronium were intravenously injected to induce anesthesia. The first convulsive response （ T1 ） in the four strangulated stimuli up to the maximum inhibition of tracheal intubation and recorded time. Intravenous infusion of propofol, plasma concentration of 3 - 5 μg/mL and intermittent intravenously injected remifentanil maintenance anesthesia. 50 mg of rocuronium bromide diluted in O. 9% NaCl 50ml, when T1 returned to 10%, the patients were given intravenous infusion of dilute rocuronium, to maintain patients with T1 in 5% to 10%, until the patients consciousness recovery, removal of tracheal tube. Results There were no statistically significant differences in SBP, DBP, MAP and HR between the two groups （ t = 0.15, P = 0.44 ; t = 0. 17, P = 0.43 ; t = 0. 09, P = 0.46 ; t = 0. 31, P = 0.38 ; ）. The DBP, MAP, HR levels increased during intubation, SBP decreased, and the differences of SBP and DBP were statistically significant （ t = 2.33, P = 0.01 ; t = 2.18, P = 0.02 ; t = 3.44, P = 0.00 ; t = 3.09, P = 0.00 ）. Muscle relaxation index ： The onset time [ （98.28 ＋ 19.97 ） s ], maximum effect duration [ （ 19.97 ± 1.80） s ], T1 recovered to 10% [ （ 26.45 ±0. 94）min ] ,T1 recovered from 10% to 25 % [ （13.14 ± 1.12）min ], the recovery index [ （11.67 ± 0.36）mini in the observation group were better than those in the control group （t = 2.57 ,P = 0.01 ;t = 3.11 ,P = 0.00 ;t = 3. 127, P = 0.00;t = 5.23, P = 0.00;t = 15.31, P = 0.00）. The tracheal intubation condition of the observation group was superior to that of the control group, but the difference was not statistically significant （ P 〉 0.05 ）. Conclusion There is no statistically significant difference in vital signs between patients with benign and malignant tumors afterrocuronium bromide, but the effect of rocuronium bromide on muscle is more sensitive in benign tumor than malignancy, and the onset time and recovery time is shortened. The overall intubation conditions have no significant differences. In the future selection of rocuronium bromide as muscle relaxants in the case of patients with benign and malignant tumors, can choose the appropriate anesthesia, in terms of dose, additional frequency should be considered.